Journal of Infection Prevention recent issues

Redefining the irreducible minimum -- a long journey in a short time

Kiernan, M. — Mon, 23 Nov 2009 07:03:11 PST

Efficacy of pre-procedural rinsing in reducing aerosol contamination during dental procedures

Purohit, B., Priya, H., Acharya, S., Bhat, M., Ballal, M. — Mon, 23 Nov 2009 07:03:11 PST

Our objective was to determine the efficacy of pre-procedural rinsing with chlorhexidine in reducing bacterial aerosol contamination during use of ultrasonic scaler and high speed air turbine handpiece. Twenty patients, ten each for the two groups who were found to satisfy the inclusion criteria were selected for the study. Four predesignated locations of the dental clinic were chosen to be evaluated for each patient using blood agar plates. Aerosols were collected during treatment procedures for control and experimental quadrants. Results showed that a regimen of 30-seconds pre-procedural rinsing with 0.12% chlorhexidine gluconate before dental procedures consistently reduced colony-forming units than without rinsing due to the ability of antiseptic mouthwash to inhibit microbial growth. There was more aerosol contamination during scaling procedures than during the use of a high speed air turbine handpiece. The conclusion is that chlorhexidine is an effective primary measure in reducing aerosol cross-contamination when using dental devices in a dental set up.

An adjusted funnel plot methodology for benchmarking targeted local healthcare associated prevalence surveys

Cairns, S., Stewart, S., Allardice, G., Reilly, J. — Mon, 23 Nov 2009 07:03:11 PST

We report the development of a local healthcare associated infection prevalence survey methodology that uses multivariate adjustment and funnel plots to facilitate benchmarking of local survey results against Scottish National HAI Prevalence Survey data. The tool provides robust and consistent results that can be used to inform infection control strategy.

Correlation between the incidence of nosocomial aspergillosis and room reconstruction of a haematological ward

Hutter, G., Ganepola, S., Thiel, E., Blau, I. — Mon, 23 Nov 2009 07:03:11 PST

Invasive pulmonary aspergillosis (IPA) represents ~ a major cause of morbidity and mortality in patients I with impaired function of the immune system such as in patients with acute myeloid leukaemia (AML). We investigated the in uence of the patients’ room occu- pancy and the sanitary facilities with regard to the inci- dence of IPA after reconstruction of a haematological ward. This is a retrospective cohort-control study in patients with newly diagnosed AML. Thirty ve patients were treated before and 28 patients in the time after the reconstruction works. The median time of neutropenia was 18.5 days vs. 19.5 days. Twelve patients before and 11 patients after the reconstruction developed IPA (p = 0.794). The incidence of IPA did not decrease after a reduction in the patients’ occupancy and improvement of the sanitary equipment. This study emphasises the presumed importance of optimal physical barriers, e.g. air ltration and/or antimycotic prophylaxis in high-risk patients.

Innovative infection prevention and control teaching for nursing students: a personal reflection

Burnett, E. — Mon, 23 Nov 2009 07:03:11 PST

A crucial part of our role as Infection Prevention and Control Practitioners is to develop, facilitate and evaluate the teaching and learning of students and healthcare workers. However, creating an environment for participation, interaction and socialisation whilst effectively stimulating reflective and critical thinking in order to promote good practice can be challenging. This paper is a critical reflection, based on Gibb’s model of reflection to demonstrate the development, facilitation, support and evaluation of learning using an innovative, interactive method.

Effective teaching on infection prevention and control: it's all about what learning is going on

Prieto, J. — Mon, 23 Nov 2009 07:03:11 PST

MMR Vaccine and Healthcare workers

Green, D. — Mon, 23 Nov 2009 07:03:11 PST

Should the government's deep cleaning hospitals programme have been evaluated?

Ayliffe, G. — Mon, 23 Nov 2009 07:03:11 PST

Intravenous therapy and intravenous access

Weaving, P. — Thu, 27 Aug 2009 23:45:56 PDT

Dr Thomas Latta: the father of intravenous infusion therapy

MacGillivray, N. — Thu, 27 Aug 2009 23:45:56 PDT

The paper reviews the work of Dr Thomas Latta who during the cholera epidemic of 1831—32 pioneered the use of intravenous saline infusion in the treatment of cholera. The reaction of the medical profession to this new therapy is described and the reasons for the profession’s failure to acknowledge the importance of this advance is analysed. The reasons why the name of Thomas Latta and his contribution did not survive his death in 1833 are discussed and the contributions of twentieth century scholars in remembering his work are highlighted.

The family of vascular access devices

Kelly, L. J — Thu, 27 Aug 2009 23:45:56 PDT

dequate intravenous access is of paramount importance for patients in both acute and community care. Advances in catheter materials and techniques have resulted in a range of vascular access devices being available for use in clinical settings. This article will present an overview of vascular access devices and provide the most relevant information regarding the indications for the use of each device. For the purpose of this article the devices will be divided into short-term, intermediate-term or long-term devices.

Evaluation of the clinical performance of a chlorhexidine gluconate antimicrobial transparent dressing

Moureau, N. L., Deschneau, M., Pyrek, J. — Thu, 27 Aug 2009 23:45:56 PDT

Each year, an estimated 250,000 cases of central

line associated bloodstream infections occur in hospitals in the United States (CDC, 2005). Reduction of CRBSI has become a major focus for education and initiatives to improve practice. Various antimicrobial agents and practices are supported with evidence to demonstrate impact on CRBSI. The broad spectrum activity of chlorhexidine as an antibacterial, antiviral, and antifungal agent is well accepted (Denton, 2001).

The purpose of this clinical evaluation was to statistically validate the performance of a new chlorhexidine gluconate (CHG) gel dressing. A fully integrated transparent dressing with a CHG gel pad was evaluated in six different facilities across the United States over a period of 73 days with 64 different clinicians. A total of 500 CHG gel dressings were applied during the evaluation period. The clinicians were asked to evaluate 16 levels of performance criteria of the new CHG gel dressings and compare these areas of performance to the performance of their current CHG disk plus transparent dressing being used at their facility. Their current dressing was replaced with the new CHG gel dressing. All sites changed dressings at 24—48 hours as needed, and then at seven days. The evaluation questions were striated into four performance groups: ease of application, gel dressing performance, securement function and ‘other’. In all 16 levels of performance ratings, the CHG gel dressing was rated ‘same as’, ‘better’, or ‘much better’. In addition to the antimicrobial advantages of a CHG gel dressing, clinical data demonstrates the following benefits: ease of use of a one piece CHG gel dressing, ability to fully visualise the insertion site through the gel, and absorption of fluid under the dressing. The new CHG gel dressing was well tolerated by patients and performed in a manner that equalled or well exceeded the current two step process of antimicrobial dressing application.

Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care

Rowley, S., Clare, S. — Thu, 27 Aug 2009 23:45:56 PDT

septic technique is a critical last line of defence between patients and clinical staff. Aseptic Non Touch Technique (ANTT) recognises this and is based on the premise that reducing the variables in aseptic practice across large clinical workforces by standardising aseptic technique will improve quality of practice and subsequently infection rates. The scale of adoption of ANTT in the National Health Service (NHS) continues to grow, with uptake currently estimated at between 150—250 NHS hospitals using ANTT as a standard aseptic technique. To better understand how effectively the implementation process was working in different trusts a convenience sample of acute trusts (n=7) was reviewed. The trusts used the recommended ANTT implementation framework and applicable audit tools. Feedback was requested regarding the implementation process as well as healthcare associated infection (HCAI) trends mapped before and after ANTT implementation. All seven trusts had found the ANTT implementation process an effective tool for standardising aseptic practice across large clinical workforces. Data reviewed from five of the trusts suggests the process impacted positively on HCAI trends. Limitations include appreciating ANTT implementation alongside other infection control interventions. More controlled studies appear to be warranted, especially now that ANTT is the most common standard aseptic technique in NHS hospitals.

Blood cultures: towards zero false positives

Thompson, F., Madeo, M. — Thu, 27 Aug 2009 23:45:56 PDT

The culture of micro-organisms from blood is an essential laboratory test for the diagnosis of bacteraemia. Early positive results provide valuable diagnostic information on which appropriate antimicrobial therapy can be initiated. Like any tests, however, false-positive blood culture results can limit the utility of this important tool. These false-positive results arise due to contamination. Reports from NHS trusts and equipment suppliers suggest these contamination rates could be as high as 10% (Department of Health (DH), 2007). A variety of strategies have been investigated and employed to decrease contamination rates. This article describes the utility of a variety of approaches to reduce the number of false-positive percutaneous blood cultures specifically in the adult population.

Writing a business case for the expansion of service: expanding the IV therapy team, from start to finish

Bolton, D. — Thu, 27 Aug 2009 23:45:56 PDT

Health professionals wishing to expand the service that they offer to their patients must present their employers with a convincing cost-effective and evidence-based rationale for doing so. This article outlines the development of a business case to expand the intravenous therapy service in an English National Health Service trust.

The Berlin Declaration

Weaving, P. — Fri, 28 Aug 2009 04:07:36 PDT

Storytelling: its place in infection control education

Cole, M. — Fri, 28 Aug 2009 04:07:36 PDT

It is generally accepted that hand hygiene is the single most effective measure to prevent health care associated infection. Similarly, education is thought to be the cornerstone of effective practice. While common sense supports the notion that hand hygiene compliance would be enhanced by producing a well informed health care worker, traditional didactic methods of teaching are often poor at invoking and sustaining behaviour change. Storytelling is gaining popularity as an educational activity as it is said to stimulate thought, reflection and enhance the learning experience. This paper, describes one way in which storytelling may be used within a hand hygiene improvement strategy.

Using students on a short educational placement with an infection prevention team to assist in implementation of universal MRSA screening: achieving educational outcomes and identifying policy compliance

Cooper, T., Brooks, J. — Fri, 28 Aug 2009 04:07:36 PDT

his article describes how an infection prevention team (IPT) used an interprofessional group of student healthcare professionals on a short placement to audit meticillin resistant Staphylococcus aureus (MRSA) screening policy compliance in the run-up to implementation of a new national MRSA screening target in England. It highlights the resource required by the IPT to support the group, the process of the audit and results, the experience of the students, and the policy and learning outcomes from both the audit and the experience of the placement. Other teams may find a similar approach beneficial for their organisations.

Indulging curiosity -- researching infection prevention

Loveday, H., Prieto, J., Hodgson, G., Tanner, J. — Fri, 28 Aug 2009 04:07:36 PDT

A key objective in the IPS research and development strategy is to increase research capability and capacity among the Society’s membership. This article summarises the recent work of the IPS Research and Development Group. On the fiftieth anniversary of the appointment of the first infection control nurse the IPS are launching annual research awards to encourage research active practitioners to build and improve their research skills and make a significant contribution to evidence based practice in the specialty.

Can education and training for domestic staff increase awareness of infection control practices and improve cleanliness within hospitals?

Aziz, A.-M. — Fri, 28 Aug 2009 04:07:36 PDT

Patients and the public are rightly concerned about cleanliness in hospitals. In response to these concerns a review of current infection prevention and control education and training for domestic staff was investigated. This review elicited a project that analysed whether education and training for domestic staff can increase awareness of infection control practices and improve cleanliness. A series of methods were introduced to gather information pre- and post-training. The project highlighted significant awareness deficiencies of the basic principles of infection prevention and control; it also showed that many domestic staff received little introduction to infection prevention and control practices when starting employment and updates were seldom followed up. The introduction of the Infection Prevention and Control Workbook for Domestic Staff improved domestic staff awareness of infection prevention and control practices on the wards. The workbook was tailored to the particular working practices of the organisation and the infection prevention and control team felt the workbooks were a great way to learn. This project highlighted that only by providing education and training in infection prevention and control can we be assured that domestic staff deliver a service that is safe and correct.

Debating the appropriateness and effectiveness of regulation as a mechanism to manage and control the risk to health from tattooing and body piercing activities

Chalmers, C. — Fri, 28 Aug 2009 04:07:36 PDT

here is currently an overwhelming trend towards the implementation of more stringent measures to govern tattooing and body piercing practices, with state-controlled regulation being targeted most frequently as the current strategy of choice. The aim of this type of regulation within the tattooing and body piercing industry is predominantly to introduce consistent controls, which can then assist in the management and reduction of associated risk to health from such activities.

This third of three articles on the topical issue of tattooing and body piercing considers the appropriateness and effectiveness of state controlled regulation as a mechanism for implementing these tighter controls, and ultimately for managing and reducing the associated risk to health from tattooing and body piercing.

Vaccination uptake by healthcare workers

Millership, S., Cummins, A. — Mon, 29 Jun 2009 07:58:23 PDT

A review of the risks and disease transmission associated with aerosol generating medical procedures

Davies, A., Thomson, G., Walker, J., Bennett, A. — Mon, 29 Jun 2009 07:58:23 PDT

Several medical procedures, including bronchoscopy, intubation, and non-invasive ventilation, frequently used in the treatment or diagnosis of respiratory diseases, have been identified as potentially `aerosol generating'. It is thought that the nature of the `aerosol generating' procedure (`AGP') results in an infectious aerosol beyond that which would normally be released by a patient coughing, breathing, or talking, presenting an increased risk to any healthcare worker in proximity to the patient. Smoke models on dummies have provided a visual image of possible aerosol behaviour and indicate a possible zone of transmission. However, they are not necessarily representative of the behaviour of a respiratory aerosol and any infectious particles contained therein. No quantitative study has yet been carried out on AGPs. Bronchoscopy and sputum induction have been associated with nosocomial transmission of tuberculosis, and guidelines have been produced describing the appropriate ventilation, isolation and respiratory protection that should be applied when carrying out such procedures. The uncertainty surrounding AGPs makes it difficult to construct effective infection control policy. The protection of healthcare workers is paramount. However, during a pandemic, resources may be stretched. Therefore it is important to clarify whether these procedures do generate aerosols.

Re-using intermittent pneumatic compression garments designed for single-patient-use is a potential source of cross-infection

Tweed, C., Wigglesworth, N. — Mon, 29 Jun 2009 07:58:24 PDT

Hospital acquired illnesses such as healthcare associated infection (HCAI) and venous thromboembolism (VTE) are often preventable; however, they occur frequently, are hugely expensive and cause increased patient morbidity and mortality.

Intermittent pneumatic compression (IPC) has been proven to reduce the risk of patients developing a deep vein thrombosis (DVT). DVT prophylaxis IPC garments are designed to be single patient use, however anecdotally some hospitals re-use these products on multiple patients. This study examines the bacterial bio-burden present on IPC garments from three different manufacturers after an episode of single patient use and compares these results to a sample of unused (clean) garments. Sixty-one percent of used garments recorded >100 colony forming units (CFU) present on at least one sample plate, while the samples taken from unused garments reported either no growth (67%) or had very few organisms (less than five CFU) present (33%). IPC garment wear time and/or presence of graduated compression stockings worn beneath the garment had no impact on reducing the garment bio-burden.

After an episode of single patient use, IPC garments carry a significant bio-burden and could be a source of pathogens. DVT prophylaxis IPC garments should be utilised as single patient use.

Appraising the need for tighter control over the practices of the tattooing and body piercing industry

Chalmers, C. — Mon, 29 Jun 2009 07:58:24 PDT

Tattooing and body piercing have had a resurgence in popularity over the past few decades, taking the activities of the industry from a place on the fringes of society into a position of mainstream status. This shift has led to debate on the level of legislation and control over the industry's practices, where concerns around risk to public health from such practices have prompted calls for tighter control over the industry (Anderson, 2006; Noah, 2006).

This debate, however, is arguably more complex than simply reflecting upon the association between tattooing and body piercing activities and the risk of infection.

This is the second in a three-part series of articles on the topical issue of tattooing and body piercing. It highlights and discusses additional key factors that have been influential, either explicitly or implicitly, within the debate to determine the need for tighter controls over the tattooing and body piercing industry.

Investigation into the effect of an alcohol-based hand product on infection rate in a nursing home setting

Roberts, C., Roberts, J., Roberts, R. — Mon, 29 Jun 2009 07:58:24 PDT

The study assessed the impact on nursing home (NH) resident infection rates of providing staff with a personal alcohol-based hand product (ABHP) with and without training on its use.

Fifteen North Wales NHs were recruited and randomly allocated into one of three groups. All monitored infection rates throughout the study period of 18 weeks (Phase I [weeks 1—9], Phase II [weeks 11—19]). NHs used liquid soap and water for hand washing throughout the study. Groups B and C introduced interventions during week ten: Group B were provided with personal ABHPs without training on use; Group C personal ABHPs with standard training from the sponsoring hand hygiene company. Infection rates between groups and pre- and post-intervention were compared.

Infection rates (per 1,000 bed days) for Phase I vs. Phase II of the study were: Group A: 6.99 vs. 7.16; Group B: 6.08 vs. 3.46; and Group C: 5.04 vs. 6.78 respectively. Change in infection rates in Groups B and C pre- and post-intervention did not reach statistical significance, p = 0.097 and p = 0.072 respectively.

Comparison of rates in non-intervention Group A with the intervention groups indicated a significantly lower rate after the intervention in Group B (p = 0.035) but not Group C (p = 0.765).

Findings are limited due to sample size; introduction of personal ABHPs with training did not reduce infection rates. This conflicts with other studies examining education and improvement of hand hygiene compliance. However, infection rates fell in NHs not receiving training, possibly mediated through a sense of `ownership' of the intervention.

Should the UK government's deep cleaning of hospitals programme have been evaluated?

Brown, C. A, Lilford, R. J — Mon, 29 Jun 2009 07:58:24 PDT

Background: In September 2007, the UK government announced a £57.5m programme of `deep cleaning' for every NHS hospital in England. The programme was met with some scepticism and this paper provides an outline economic evaluation of the programme. Methods: We use information on costs of the programme, the opportunity cost of closing wards for cleaning and cost savings and health gains resulting from cleaning to model the reduction in the annual hospital acquired infection (HAI) rate required for the programme to be cost-effective. We compare our results with the potential headroom available, based on the available evidence and the beliefs of 15 experts. Findings: If wards are closed for two days for cleaning, an annual HAI reduction of 7.8% (21,000 fewer non-fatal infections and 355 fewer deaths nationwide) would be required at a cost-effectiveness threshold of £30,000 per Quality Adjusted Life Year. This figure does not compare favourably with the effectiveness estimates of <1% obtained from the available evidence on cleaning and the pooled prior beliefs of 15 experts. Interpretation: Our analysis shows that as it is very unlikely the deep cleaning programme would have been cost-effective, a full evaluation would not have been a good use of public funds.

Diary of Events

Mon, 29 Jun 2009 07:58:24 PDT